Children born prematurely are at risk for a variety of social, behavioral, and academic problems. Although some VLBW children have major disabilities resulting from their premature birth and/or subsequent medical complications, the majority of these children have milder forms of dysfunction (Hack et al., 2000; Halsey, Collin, & Anderson, 1996; Msall et al., 1991; Saigal, Szatmari, Rosenbaum, Campbell, & King, 1991; Teplin, Burchinal, Johnson-Martin, Humphry, & Kraybill, 1991). Typically, they demonstrate subtle problems such as inattentiveness, difficulty following directions, problems adjusting to school, and poor school performance, especially when compared to their normal birth weight peers (Botting, Powls, Cooke, & Marlow, 1997; Breslau et al., 1996; Breslau & Chilcoat, 2000; Davis, 2003; Hoy, Bill, & Sykes, 1988; Klein, 1988; Sykes et al., 1997; Teplin et al., 1991). Because of the subtle nature of these problems, they often go unrecognized until after the children enter school. Approximately half of very low birth weight (< 1500 g; VLBW) children receive special educational services even in the absence of major disability. Unfortunately, the delay in diagnosis and treatment often necessitates costly remedial educational services and can have a long-term effect on their cognitive, emotional, and behavioral development and on academic success (Halsey et al., 1996; Msall et al., 1991; Saigal et al., 1991; Whitfield, Grunau, & Holsti, 1997). It is clear that a better understanding of the underlying developmental processes that lead to poor outcomes, particularly those related to academic achievement, is needed in order to develop specific interventions to ensure that these high-risk children reach their full potential.
Most researchers and clinicians would agree that adverse outcomes are the result of complex interactions among child and environmental factors. However, much is still unknown about the specific causal factors and the way in which biological and environmental factors interact to produce less than optimal developmental outcomes.
One important child factor shown to relate to children's developmental and academic achievement outcomes is temperament (Rothbart & Jones, 1998). Recent conceptualizations of temperament describe it as individual differences in self-regulation and reactivity that occur during development as a result of the dynamic interaction between the individual and his/her environment (Chang & Burns, 2005; Eriksson & Pehrsson, 2003; Kochanska, Murray, & Harlan, 2000; Rothbart, Ahadi, Hershey, & Fisher, 2001; Rothbart & Jones, 1998). This approach to temperament has largely been pioneered by Rothbart and others who contend that early regulatory control of arousal, reactivity, state, and attention form the basis for theories of temperament (Derryberry & Rothbart, 1997; DiPietro, Costigan, & Pressman, 2002; Huffman et al., 1998). Temperament includes physiological, motor, state, and attentional regulatory systems that are present at birth (Als & Lawhon, 2004; Rothbart & Bates, 1998). Although temperament is biologically based and stable over time, it is modifiable by maturation and experience (Rothbart & Bates, 1998). The human infant has been described as having a constitutional predisposition to react to the environment by using approach and avoidance behaviors to regulate the amount and type of stimulation solicited from the environment (Als & Lawhon, 2004; Rothbart & Bates, 1998). Infants with greater self-regulatory capacities have greater control over the intake of stimulation from their environment (Langkamp & Pascoe, 2001; Rothbart, Derryberry, Reed, & Hershey, 2000).
Recently, some temperament researchers have suggested that new methods are needed to measure temperament because previous instruments did not consider the developmental nature of temperament throughout early childhood and because there was considerable overlap, conceptually, among the dimensions underlying temperament (Rothbart & Bates, 1998; Rothbart & Jones, 1998; Rothbart & Mauro, 1990). Rothbart's framework allows researchers to better explore temperament variability (Rothbart et al., 2001) and may be particularly important when studying children who are at risk for problems with attention regulation such as children born prematurely. Rothbart's (1996) Children's Behavior Questionnaire (CBQ) includes assessments of 16 dimensions (see Method). Using factor analysis Ruff and Rothbart (1996) identified 16 dimensions, which have been clustered into 3 factors consisting of Effortful Control, Extraversion, and Negative Affectivity.
The first factor, Effortful Control, includes regulatory functions such as inhibition and activation responses (Jones, Rothbart, & Posner, 2003; Rothbart, Ellis, Rueda, & Posner, 2003) and has often been described in relation to executive control of attentional and other cognitive processes (see Chang & Burns, 2005 and Eisenberg et al., 2004 for discussions of distinctions between effortful control and attention). The second factor, Extraversion, has been linked to positive emotionality (Rothbart & Bates, 1998; Rothbart et al., 2003). Negative Affect, the third factor, refers to negative emotionality (e.g., anger, frustration, fear, and sadness) (Rothbart et al., 2001).
Of the three factors, research has shown that effortful control is a key component to children's cognitive and academic outcomes in normally developing populations (Rothbart & Jones, 1998). Effortful control is a biologically based and stable behavioral style characterized by the ability to self-regulate reactivity in response to both internal and external stimuli (Rothbart et al., 2003). Children who are rated low in effortful control typically demonstrate poor attention skills and achievement outcomes. In addition, temperament, including effortful control, has been linked to social competency (Eisenberg & Fabes, 1992; Saylor, Boyce, & Price, 2003), behavior problems (Blair, Denham, Kochanoff, & Whipple, 2004; Caspi, Henry, McGee, Moffitt, & Silva, 1995; Eisenberg et al., 2004; Olson, Sameroff, Kerr, Lopez, & Wellman, 2005; Paterson & Sanson, 1999; Saylor et al., 2003), resiliency (Eisenberg et al., 2004), childhood adjustment (Blair et al., 2004; Eisenberg et al., 2004), cognitive and learning skills (Gartstein & Rothbart, 2003; Rothbart & Jones, 1998), motivation (Chang & Burns, 2005), disruptions in family functioning and parent-child interactions (Eriksson & Pehrsson, 2003; Gauvain & Fagot, 1995; Kochanska et al., 2000; Paterson & Sanson, 1999), and alterations in teacher-child interactions (Rothbart & Jones, 1998). Recent research has shown that structured environments can buffer the negative consequences associated with low effortful control (Gartstein & Fagot, 2003; Kochanska et al., 2000). So, although effortful control is biologically based, there are important intervention implications (Rothbart et al., 2001; Rothbart et al., 2003).
The utility of a temperament framework has yet to be fully explored in children born prematurely. From birth, delays in regulatory control may impact specific factors of temperament, such as effortful control, in children born prematurely. Given that stability in the infant's ability to maintain state matures at approximately 36 weeks gestation (DiPietro et al., 2002), these children may not be equipped to regulate their internal processes and, accordingly, cannot control the intake of external stimulation. Some have linked early …